IVF or In vitro fertilisation is one of the significant scientific achievements of the 20th century, which help to solve the problem of infertility almost completely. IVF – a technology that allows you to recreate the conditions for conception outside the human body. It includes: getting mature egg cells and sperms, their merging, the first hours and days of embryo development, preparing the uterus for implantation.
The main indications for the IVF procedure are abnormalities of the fallopian tubes, decreased sperm quality, and endometriosis.
The effectiveness of treatment is determined by various factors. In addition to the causes of infertility, an important role plays the duration of infertility and the age of the woman. In the Clinic of Professor Stefan Khmil we get pregnancys in more than 45% of IVF cycles.
The IVF procedure can be divided into several stages:
The first stage: stimulation of the ovaries
The second stage: the puncture of the follicles, getting the egg cells
Third stage: sperm preparation
Fourth stage: fertilization In vitro – adding sperm to the egg cell
Fifth Stage: embryos cultivation
Six stages: the transfer of embryos to the uterine cavity
Seventh stage: support for embryos implantation
Eighth stage: diagnostics of pregnancy
Stimulation of ripening of eggs cells
The main difference between the stimulated cycle in the IVF program from the natural one is that under the influence of hormones several eggs ripen, not one. Then ripe egg cells are punctured from the ovary to get the fertilization in vitro.
Not every egg can be fertilized, and not all embryos have the same chances of implantation – so there is a need to get several eggs. The few embryos, those for which the probability of implantation is the highest are chosen for transferring. To get the maximum number of mature egg cells, but with the avoidance of complications, hormonal therapy is selected individually.
During stimulation, an ultrasound examination is performed. This allows you to control the number and size of the follicles, as well as the thickness of the endometrium. Only by this way you can choose the optimal moment for the puncture of the follicles. Also, such examination can reduce the risk of hyperstimulation.
The puncture of the follicles
Shortly before ovulation, the egg cells are collected from the follicles (puncture of the follicles). The egg cells are picked up to the time of ovulation, because after ovulation the egg cell enters the fallopian tube or abdominal cavity, where it becomes practically inaccessible.
The follicle puncture is performed through the vagina under the control of the ultrasound. In our clinic, general anesthesia is used for analgesia. This procedure does not require hospitalization. After discussing the results of the puncture with the woman and if she feels good she go home.
For fertilization of egg cells on a day of a puncture it is necessary to have a “fresh” sperm of a man. Before fertilization, semen is treated in a laboratory in such a way that the sperm motility is optimal. Further, the egg and sperm both need to be cultured in an incubator in a growth medium for 24 hours.
Embryos are cultivated from 2 to 5 days more. Supervision of their division is conducted. In parallel, we conduct the selection of those embryos that have the best chance of implantation and will be used for implantation. The remaining good quality embryos can be stored at very low temperatures for further attempts (cryopreservation of embryos).
Transferring embryos to the uterine cavity is a painless procedure. It is performed on the 3rd or 5th day after the puncture. The transfer of embryos occurs with the help of a very thin, soft plastic catheter, which is inserted into the uterus through the vagina and the cervical canal. No more than two embryos are transmitted to the uterine cavity, as the transfer of more embryos significantly increases the risk of multiple pregnancy.
After transferring the embryos to the uterus, progesterone and estrogen is usually prescribed to support the implantation of the embryo. Two weeks after the transfer of embrios, the first pregnancy test is performed.
In order to know exactly how pregnancy proceeds, and to get timely help, it is necessary to be under the supervision of a gynecologist. Obstetricians of the Clinic of Professor Stefan Khmil have a lot of experience in infertility treatment by IVF program. Our clinic also provides prenatal diagnostics and monitoring of pregnancy. Controlling the course of pregnancy is very important for a successful pregnancy and the birth of a healthy child.
ICSI (Intra Cytoplasmic Sperm Injection)
ICSI (Intra Cytoplasmic Sperm Injection) is the procedure in which a spermatozoon is injected directly into an egg cell with the help of a micro-needle. This method is very efficient and usually is used in the heavy forms of masculine infertility, when the quantitative or qualitative indexes of sperm are considerably reduced.
With the help of micromanipulators, the best quality sperm is selected under a microscope. It is fixed in a micro-needle, by which the puncture of a shiny shell of the egg cell is carried out, and then the sperm is injected into the cytoplasm of the egg cell. Thus, the fertilization of all egg cells, obtained during the puncture, is carried out.
As a result of fertilization, on the next day a zygote is formed containing two nuclei – mother’s and father’s. From it the embryo will develop itself.
In our clinic, the ICSI procedure is performed by the latest and most up-to-date micro-manipulator The Integra Ti ™.
Stages of ICSI:
- The mature egg cell is held by a specialized pipette.
- A very delicate, sharp and hollow needle is used to immobilize and pick up a single sperm of good quality.
- Then this needle is inserted through the shell of the egg cell into the cytoplasm
- The sperm is injected in the cytoplasm and the needle is removed.
- The egg cells are checked the next morning for evidence of normal fertilization.
Indications for the ICSI method:
♦ oligozoospermia – the concentration of spermatozoa less than 2 million / ml;
♦ stenozoospermia – the number of active spermatozoa less than 1 million mobile sperm in 1 ml of ejaculate;
♦ teratozoospermia – less than 10% of spermatozoa of normal morphological structure;
♦ the presence of high titer of antisperm antibodies in ejaculate, which will interfere the natural fertilization, even in cases of normal concentration of sperm;
♦ absence of fertilization in previous IVF attempts;
♦ the age of a woman is more than 38 years, a man is more than 45 years old.
In general, the incidence of pregnancy after ICSI in our clinic is high, 45-50%.
If you faced with a problem of infertility treatment, the specialists of the Clinic of Professor Stefan Khmil will do all the best to help you.